Health inequalities & Covid-19: the situation in

FranceMichelle Kelly-Irving

Inserm scientist, EQUITY team, CERPOP, Université Toulouse III, France

Director of the Interdisciplinary Federal Institute for Research on Health & Society

An incomplete view of the situation

In most countries we lack good quality data to allow us to quickly examine the social distribution of a new disease like Covid-19

Oxfam France, 10 avril 2020

The disproportionately high mortality rate in the poorest department of mainland France, Seine-St-Denis,

became headline news

France: EpiCov study

4.5%SarsCov2 Seroprevalence in the French population: May 2020

EpiCov wave 1During the spring lockdownN= 12 114

Warszawsk et al 2020, https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1167.pdf

France: EpiCov study

4.5%SarsCov2 Seroprevalence in the French population: May 2020

5%11%

Born outside of Europe9%Overcrowded housing9%

Women

Health care workers

Warszawsk et al 2020, https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1167.pdf

EpiCov wave 1During the spring lockdownN= 12 114

Social conditions & lockdown

Of participants were "never or rarely“ able isolate an unwell person in a separate room to avoid infection

21%11% vs 5%

11% of people with no educational qualifications "always, almost or most often" needed help understanding medical prescriptions compared to 5% of participants in the other education categories

Baromètre Covid study during lockdown wave 4N= 5000

Maurel et al 2020, https://epidemic.hypotheses.org/category/resultats

30%This increased to 30% among participants with no educational qualifications

COVID-19& inequalities

The elephant in the room

The elephant in the room: race & ethnicity

“there is nothing ‘distal’ about structural discrimination because it is intimately encountered and embodied, day in and day out” N. Krieger AJPH 2016

Queues outside a foodbank in Seine-St-Denis in April 2020 (Le Parisien)

Excess all cause mortality & place of birth

SS Africa

114%

N Africa

55% France

22%

Asia

90%

During spring 2020 lockdown excess deaths for people born in Asia, N Africa, SS Africa far exceeds that of French born (Insee, 2020)

https://www.insee.fr/fr/statistiques/4627049#graphique-figure4

EpiCov – Place of birth & Covid-19

0.0

1.0

2.0

3.0

4.0

5.0

UNADJUSTED ADJUSTED

Odds of testing positive for SarsCov2 for people born outside of Europe compared to French-born people before & after adjusting for socio-economic & housing

OR &95%CI

2.4

1.6

Missing link: data

Data governance & health inequalitiesunlocking the barriers

Ethically safe linkage:-Interoperable identifiers

-AI methodsSocial Data:

• Census etc• Work & retirement• education

Health Data:

• Routine collection• Hospital• General Medicine

THANK YOU